非转移人表皮生长因子受体2阳性乳腺癌新辅助治疗后病理完全缓解的影响因素及列线图模型建立

Influencing factors for pathological complete response after neoadjuvant therapy for non-metastatic human epidermal growth factor receptor 2 positive breast cancer and establishment of nomogram model

目的 探讨非转移人表皮生长因子受体2(HER2)阳性乳腺癌患者新辅助治疗后病理完全缓解(pCR)的影响因素并建立列线图模型。方法 收集97例非转移HER2阳性乳腺癌患者的病历资料,以pCR评价疗效,进行单因素和多因素Logistic回归分析并构建列线图预测模型。结果 多因素分析结果显示,Ki-67、血小板分布宽度(PDW)及抗HER2治疗情况均为HER2阳性乳腺癌患者新辅助治疗后pCR的独立影响因素(P﹤0.05)。构建列线图,利用Bootstrap对列线图预测模型进行验证,列线图模型校准曲线中实际曲线与理想曲线贴合良好,内部验证该模型预测值与真实值符合度平均绝对误差为0.048。结论 PDW≤14.4 fl、Ki-67﹥30%、双靶抗HER2治疗能够为接受新辅助治疗的HER2阳性乳腺癌患者带来更高的pCR率,以此构建的列线图可较准确地预测新辅助治疗疗效,为临床治疗方案的制订提供参考。

Objective To investigate the influencing factors for pathological complete response(pCR) after neoadjuvant therapy in patients with non-metastatic human epidermal growth factor receptor 2(HER2) positive breast cancer and to establish a nomogram model. Method The medical records of 97 patients with non-metastatic HER2 positive breast cancer were collected, the curative effect was evaluated by p CR, univariate and multivariate Logistic regression analysis was performed, and a nomogram prediction model was constructed. Result The results of multivariate analysis showed that Ki-67, platelet distribution width(PDW), and anti-HER2 treatment were independent influencing factors for pCR in patients with HER2 positive breast cancer after neoadjuvant therapy(P<0.05). A nomogram was constructed, and Bootstrap was used to verify the prediction model of the nomogram. The actual curve and the ideal curve in the calibration curve of the nomogram model fit well, and the average absolute error of the agreement between the predicted value of the model and the true value was 0.048. Conclusion PDW≤14.4 fl, Ki-67>30%, dual-target anti-HER2 therapy can bring higher pCR rates for HER2 positive breast cancer patients receiving neoadjuvant therapy. The nomogram constructed in this way could more accurately predict the efficacy of neoadjuvant therapy and provide a reference for the clinical treatment regimen.